Short of breath: For Canadian women, COPD deaths surpass those from breast cancer

When Irene Donaldson became anxious about her persistent dry cough and the “terrible time” that she had breathing, her physician downplayed her concerns.

Donaldson had quit smoking 15 years earlier. Her doctor ordered a chest X-ray, which was clear.

“But I kept after her—and after her—and finally she referred me to a respirologist,” says Donaldson, 79, who lives in Rockland, a town of about 11,000 an hour’s drive east of Ottawa.

Donaldson, who was 75 at the time, waited six months for that appointment, at which she had a spirometry test and was diagnosed with chronic obstructive pulmonary disease (COPD), an umbrella term for emphysema and chronic bronchitis.

Spirometry is the standard test to confirm a COPD diagnosis (see video here); chest X-rays are “seldom diagnostic” for COPD, according to international guidelines.

Now the fourth leading cause of death worldwide, COPD is expected to climb to 3rd place by 2030, according to the World Health Organization.

Despite the burden that COPD places on sufferers—and on the health care system—researchers agree that this chronic disease is under-diagnosed and under-treated and, relative to other chronic conditions, underfunded and under-researched.

It will surprise many to learn that more Canadian women are expected to die from COPD this year than from breast cancer, continuing an existing trend. This underscores COPD’s low profile as a public health issue.

In fact, COPD overtook breast cancer as a cause of death for Canadian women in 2009, according to Statistics Canada figures, and since then COPD deaths have climbed while breast cancer deaths have fallen. (The latest figures, from 2011, show 5,342 deaths from COPD, 4,958 for breast cancer.)

Back in 2006, a Canadian Lung Association report pointed out that COPD was “becoming a crucial women’s health issue.” Today it’s safe to say it is a women’s health issue. Taking Her Breath Away highlights the disturbing increase of COPD among women in the United States and was released just last year by the American Lung Association.

Getting a diagnosis

By the time that Donaldson was diagnosed with COPD, her condition was so severe that the specialist promptly arranged for her to be admitted to a 30-day in-patient pulmonary rehabilitation program in Ottawa.

While COPD cannot be cured, deterioration can be slowed down or even halted, and early diagnosis significantly improves outcomes. Donaldson needed a walker to get around when she entered the program, but after three weeks in rehab she folded up her walker and put it away.

With a (preferably early) early diagnosis of COPD, clinician scientist Pat Camp of the University of British Columbia advises that women should:

be strongly encouraged to quit smoking. If they don’t quit, their health will decline much more rapidly.

treat any chest infections aggressively with antibiotics and oral steroids to reduce inflammation. With COPD, infections rapidly get into the chest and, if untreated, patients end up in hospital with a “lung attack”.

get the pneumonia vaccination and a flu shot.

maintain physical activity—improving muscle strength and function means you put less load on your lungs, you don’t need as much oxygen.

The difficulty that Donaldson had getting her family doctor to take her concerns seriously is not uncommon. A 2011 British report, Reconsidering sex-based stereotypes of COPD, notes that COPD has “historically been considered a disease of older, white, male smokers” and that women with COPD present with somewhat different symptoms than men—more breathlessness and coughing, but less phlegm.

That report also cites an earlier (2001) study, in which researchers asked Canadian and American doctors to consider hypothetical cases of individuals—their gender was not revealed—with the symptoms of COPD.

The physicians diagnosed the female patients more often with asthma than with COPD. Only when shown the results of spirometry tests for the hypothetical patients did the doctors correctly diagnose the women—yet only 22 per cent of the doctors “would have requested spirometry after the initial presentation,” the study reported.

Indeed, a recent study found that, when they do diagnose COPD, Ontario doctors typically do not bother to confirm their diagnosis. Only about 36 per cent of those diagnosed with COPD in the decade 2000 to 2010 had the confirmatory spirometry test.

COPD is not the only condition where gender bias may play a role in diagnosis and treatment. A study recently published in the CMAJ noted that women suffering from heart attacks are treated differently from male counterparts at emergency departments.